DOD Now Eyes Lariam In Suicides

Feb 26, 2004 | United Press International

The Pentagon reversed course Wednesday and told Congress it would look into whether an anti-malaria drug developed by the Army might be causing suicides, one month after asserting the drug could not be a factor.

Assistant Secretary of Defense for Health Affairs Dr. William Winkenwerder Jr. told a House Armed Services Committee panel he would launch a study into side effects of Lariam, "to include suicide and neuropsychiatric outcomes."

He said the Pentagon would appoint a panel to help design the study, but said it could take months or years to complete. Pentagon health officials also said they would no longer use Lariam in Iraq because the malaria risk does not warrant it.

The Pentagon is studying suicides in Iraq and Kuwait during Operation Iraqi Freedom. Winkenwerder said 21 Army soldiers from units assigned to the operation have committed suicide. Army Surgeon General Lt. Gen. James B. Peake told the panel the Army is investigating another five deaths in Iraq as possible suicides, along with six deaths among soldiers in Iraq who returned to the United States and then killed themselves.

When asked about the suicide investigation late last month, Army spokeswoman Martha Rudd said the Pentagon would not consider Lariam. "We don't believe there is any connection between Lariam and suicide," Rudd said. "There is nothing to indicate that is a factor."

Four of the 21 soldiers who committed suicide in Iraq or Kuwait came from units that took Lariam, the Pentagon health officials said Wednesday. Only one tested positive for Lariam in the blood, they said.

Developed by the Walter Reed Army Institute of Research, Lariam, known generically as mefloquine, is one drug used by soldiers in Iraq to prevent malaria, which is of particular concern in hot summer months. The Food and Drug Administration warns that Lariam can cause psychosis, aggression, paranoia, depression and thoughts of suicide. The FDA also warns of rare reports of suicide among Lariam users, although it says a link has not been established.

The Pentagon has told Congress in the past that side effects from Lariam have not been a problem in the military.

Winkenwerder said Wednesday that the 21 confirmed suicides in Operation Iraqi Freedom mean a rate of 15.8 suicides per 100,000 soldiers per year. He compared that to Army suicide rates of between 9.1 and 14.8 per 100,000 in the Army between 1995 and 2002.

"While every suicide is a tragic loss, the suicide rate for soldiers deployed to OIF is not significantly different from the range of recent annual Army suicide rates," he said Wednesday.

On Jan. 14, Winkenwerder said 18 Army suicides had been confirmed, which he said meant a rate of 13.5 per 100,000. He called this "a very slight increase" above expected suicides and "on the high end of what they've seen in the past." He said then that the Army typically sees a rate of 10-11 suicides per 100,000.

The Pentagon has said it does not count suicides among troops who served in Iraq but returned to the United States before killing themselves. After returning from Iraq, at least two soldiers apparently committed suicide at the Army's Walter Reed hospital in Washington, since July; another apparent suicide occurred last month near Fort Campbell, Ky.

Veterans groups said they are alarmed by the trend.

"I fear that the military is in denial and that they are rationalizing this. As far as we're concerned, we can't even trust the numbers," Wayne Smith, an adviser to the Vietnam Veterans of America Foundation, told UPI this month.

Steve Robinson, a veterans' advocate with the National Gulf War Resource Center, told a House panel last month he was concerned about the mental toll of war on troops, and asked for an investigation into Lariam.

"The military is ignoring this drug's known side effects," said Robinson. "In some cases, they are lying to family members and act as if they are baffled by the high suicide and depression rates."

In October, Sen. Dianne Feinstein, D-Calif., asked Secretary of Defense Donald Rumsfeld to reconsider the military's use of the drug. "Given the mounting concerns about Lariam as expressed by civilians, service members and medical experts about its known serious side effects, I strongly urge you to reassess the (Defense Department's) policy on the use of Lariam," she wrote Rumsfeld.

UPI reported that some soldiers involved in a string of murder-suicides at Fort Bragg, N.C., in the summer of 2002 had taken the drug in Afghanistan.

The Army surgeon general dispatched a team to investigate the deaths. Their report blamed marital problems and the stress of deployment and said that Lariam was an "unlikely" cause for the entire cluster of deaths because not everyone suspected in the homicides had taken it. The team did not examine the drug's possible role in any individual death.

Winkenwerder told Congress Wednesday, "Investigation has not established mefloquine as a cause in DoD murders or suicides." He did not say if the Pentagon would revisit the Fort Bragg deaths.

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